Provider Demographics
NPI:1073600714
Name:PAIN CARE ASSOCIATES OF OKLAHOMA
Entity type:Organization
Organization Name:PAIN CARE ASSOCIATES OF OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-502-7246
Mailing Address - Street 1:PO BOX 701683
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-1683
Mailing Address - Country:US
Mailing Address - Phone:918-398-9683
Mailing Address - Fax:918-398-9095
Practice Address - Street 1:6585 S YALE AVE
Practice Address - Street 2:SUITE 1110
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8384
Practice Address - Country:US
Practice Address - Phone:918-502-7246
Practice Address - Fax:918-519-7250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK538208VP0014X
OK4609174400000X
OK25659174400000X
OK16519208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200070240AMedicaid
OK200070240AMedicaid